In recent years, long-term hospitalized patients in psychiatric ward have been increasing in number and adverse effects of their physical deconditioning became a serious problem. In our study, 17 chronic schizophrenic inpatients participated in 6 weeks of training program to investigate its effectiveness. The mean age of the subjects was 56.3 years old and the mean period of hospitalization was 24.8 years. Each training session was 50 minutes long and consisted of bicycle ergometer cycling. Before and after the training period, exercise stress tests using bicycle ergometer were administered and heart rate (HR), systolic blood pressure (SBP), pressure rate product (PRP), ratings of perceived exertion (RPE), and total exercise time were measured. The scores of the Nurse's Observation Scale for Inpatient Evaluation (NOSIE) were also recorded in order to evaluate the changes of their daily behaviors. The results of pre- and post-training stress tests were as follows ; (l) Maximal HR and maximal SBP had no change. (2) Endurance time was significantly prolonged (p<0.001). (3) HR and SBP were significantly decreased in submaximal work load (p<0.01). (4) The coefficient of correlation between HR and RPE showed a slight rise (from rs=0.37 to rs=0.5O). Yet, there was a considerable "DISCREPANCY" between physiological response and subjective one. (5) In total NOSIE score, there seemed a tendency of improvement, especially the groups positive to the program showed remarkable improvement in Social Interest and Cooperation, but at the end of the program, one case took a bad turn in psychiatric symptoms. Our results suggest positive effect of physical conditioning training, in schizophrenic patient, while farther study, especially related to their behaviors, will be required in the future.

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Cerebral Vascular Accident hemiplegic Patients with Agnosia tend to lean in the opposite direction from the affected side. However, during treatment of patients without Agnosia, a high percentage of left hemiplegic patients has the same appearance. Left and Right hemiplegic patients are observed to have varying balance difficulties. A special balance board was designed to aid in observing certain subjects. The board was divided in half and each half was connected to an X-Y recorder that could measure the weight of the patients and readable date for comparisons. The board was also to be tilted to angles of 5°, 10°and 15° in both directions. A description of the studies follows. 1. For the first, 30 self ambulatory subjects were chosen, 10 were right hemiplegics, 10 were left hemiplegics and 10 were normal control subject. The board was placed in a horizontal position(0°), then tilted by 5°, 10°and 15°s to both the right and left consecutively. A record of the EMG was taken for the M. erector spinae and the M. gluteus medius. 2. The subjects for this second test were two right hemiplegic patients who could not walk, and one left hemiplegic patient with Agnosia who could not walk. All three patients were experiencing PT training for self mobility at the time. The previously described test was conducted on these three patients over a period of thirteen weeks. The results of the tests done on the two test groups are as follows. 1. When the right hemiplegic patients and the normal control patients' weight results were compared, there was no difference in measurement statistically. However, when the result of the left hemiplegic patients tests were compared with that of the normal control group, a considerable difference was noted. When the board was tilted to the left and also when in the horizontal position, the data indicated that the patients were tilting drastically to the right. Statistically, (P<0.01) a low weight measurement was observed. 2. EMG measurement of the M. erector spinae and the M. gluteus medius showed various action potential. No major difference between the two groups was seen. Apparently, EMG was unaffected by this test. 3. The result of the test done on the two right hemiplegic patients showed the same results as the first test when they became able to walk. However, the left hemiplegic patient continued to lean to the right. The patient was ambulatory but not stable. The result was similar to the first test done on the left hemiplegic patients.

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The reasons why twenty-nine discharged hemiplegic patients in the postapoplectic period decline their strength and function were studied from the viewpoint of their dairy activities. The degree of practicing ADL, the numbers of steps per day were examined, and also cardiograms were continuously recorded in their awakening period. The speed to walk 10 meter, which reveals their function, and changes in heart rate after the load test of three typical patients, which judge their physical fitness, were examined at both times just out of hospital and twenty to thirty months after leaving there. The results pointed out that patients whose walking ability declined had a tendency to have less activity, showing fewer steps per day. And training to walk being a primary part of their self-trainings, it can be said that ability to walk at leaving hospital plays a decisive role in maintaining their physical fitness and function. Home programs for hemiplegic patients should include positive training to walk which prevents the walking ability from declining.

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For the purpose of estimating the required number of physical therapists in Hyogo Prefecture, the number of patients in need of physical therapy was summed up. In general hospital of three institutes supplying us with valid replies, 28 per cent of in-patients and 8.3 per cent of outpatients were in need of physical therapy, especially, 5 per cent of the latter called for therapeutic exercise. In calculation of those numbers in social welfare and educational facilities, sufficient examination of each present condition was conducted in consideration of various factors. The results obtained ; the required number of physical therapists in Hyogo Prefecture is 1,214 in total ; 970 in medical facilities, 140 in social welfare organs, 41 in educational institution, and 63 in other institutes.

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People generally depend on nonverbal means of communication, such as gestures and postures, to socially convey human feelings quite as much as they use verbal means to do so. If the sequelae from a stroke include orofacial paralysis, the patient may be left with a facial asymrnetry that precludes effortless impartation of subtle notions. Orofacial muscles affected by the stroke are susceptible to increased tone due to abnormal postural tone in other parts of the body, particularly in the shoulder girdle or trunk. This means that the therapist must first address the problem of abnormal postural tone throughout the body. Only after this global problem has been brought under adequate control can the therapist pursue treatment directed to improve facial expressiveness. Emphasis is then laid upon eliciting controlled voluntary muscular activity in expressions that require symmetrical movements, as in smiling or frowning. To corroborate this concept, we prospectively studied a 59 year old woman with right hemiplegia who suffered right orofacial palsy as part of her stroke. Our observations and treatment commenced four months and three days after onset of the stroke. Through four months of treatment, this patient experienced improvement in visual field limitation due to right eye closure, and a decrease in asymmetry of facial expression, such as of drooping and rightward deviation of the right side of the mouth.

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In most cases of hemiplegia motor paralysis of the lower limb recovers better than that of the upper limb. In general both in the upper and lower limbs the motor paralysis in the proximal region recovers faster than that in the distal region. Examinations by CT show that many of these paralysis are caused by lesions near the internal capsule. In the course of the treatments of many patients in our clinics we experienced 5 particular cases that showed characteristic recovering processes different from those of the above mentioned general motor paralysis. This experience raised a question as to whether such a characteristic motor paralysis is due to a particular site of lesion in the brain. Here we discuss the question, presenting that CT scan of these 5 cases and reviewing relevant literatures.

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